1. Health Coverage Updates An Affordable Care Act and BadgerCare primer for AmeriCorps members

2. What do you know about the Affordable Care Act?

3. Problems 18 – 20% uninsured rate – Affordability – Jobs – Already sick 70 million Americans in medical debt What was the ACA intended to do? Solutions in the ACA Mandatory health insurance Individual Marketplace Elimination of caps MA Expansion Guaranteed Issue

4. The Patient Protection and Affordable Care Act In Short…

5. Patient Protection… Allows young adults to stay on parents’ policies until they are 26 Eliminates lifetime limits Phases out annual limits (gone in 2014) Many preventive care services must now also be offered without co-pay or deductible 80% of your premium most go to care (MLR) No denials for pre-existing conditions! AKA Health Insurance Reforms

6. Explain it to me like I’m 5 years old What is COBRA?

7. Individual Marketplace – Subsidies for low-income individuals – Tiers of coverage New Funding for Community Health Center expansion – Hooray! Medicaid Expansion – State choice …and Affordable Care Act!

8. ACA Creates New Marketplaces TRICARE Military TRICARE Military VA Some Veterans VA Some Veterans Medicare Seniors and SSDI Medicare Seniors and SSDI Individuals and Self-Employed Small Groups 1-50 FTEs Small Groups 1-50 FTEs Large Groups 50+ FTEs Large Groups 50+ FTEs Insured Products HMOs PPOs FFS Etc. Insured Products HMOs PPOs FFS Etc. Providers Doctors Specialists Hospitals Clinics Rx Drugs Etc. Providers Doctors Specialists Hospitals Clinics Rx Drugs Etc. Insured Government Coverage Private Coverage Self- Insured Employer Individual Marketplace SHOP Marketplace Medicaid < 100% of FPL, EBD, SSI, Pregnant Women & Children Uninsured Exempt Credit: Community Advocates Public Policy Institute Avenues to Health Insurance

10. 1. Create an account

11. The Marketplace will ask you a series of questions in order to determine your eligibility 2. Apply

12. Explain it to me like I’m 5 years old What is a deductible?

13. Which Qualified Health Plan? Which Metal Tier? How much can I afford with or without APTCs and CSRs? Is my current doctor in network? Are my specific medications covered? 3. Pick a Plan

14. The individual plans sold by health insurance companies on the Marketplace are known as “Qualified Health Plans” Qualified Health Plans in Wisconsin 1.Common Ground Healthcare 2.Compcare Health Services 3.Dean Health Plan, Inc. 4.Group Health Cooperative of South Central Wisconsin 5.Gundersen Health Plan, Inc. 6.Health Tradition Health Plan 7.Medica Health Plans of Wisconsin 8.MercyCare HMO, Inc. 9.Molina Healthcare of Wisconsin, Inc. 10.Physicians Plus Insurance Corporation 11.Security Health Plan of Wisconsin, Inc. 12.Unity Health Plans Insurance Corp. 13.Arise (WPS Health Plan, Inc.)

15. Plans sold on the Health Insurance Marketplace are divided into four metal tiers, and some offer catastrophic coverage. Metal Tiers

16. Premium Tax Credits Individuals with lower incomes can receive discounts on their health insurance premium. These are refundable or advance-able, but must be reconciled at the end of the year.

17. Cost Sharing Reductions Individuals with lower incomes can also receive discounts on their deductibles and co-pays. They further stretch the value of one’s health insurance. These do not need to be reconciled.

18. Explain it to me like I’m 5 years old What is co- insurance?

19. In order to start receiving benefits, you must enroll in that plan and begin making premium payments. 3. Enroll! Enrollment Numbers through April 19: 81,274 determined/assessed eligible for Medicaid 230,516 determined eligible for Marketplace 168,721 (73%) eligible for assistance 139,815 selected a QHP* *Selected does not = complete enrollment

20. Why Should I Enroll? Because it’s good for your health! Also…

21. With some notable exceptions, the majority of Americans will be required to have health coverage for at least 9 months of each year or risk paying a penalty. Individual Mandate

22. When Can You Enroll? Open enrollment November 15 th, 2014 February 15 th, 2015 Open enrollment begins November 15 th, 2014 and ends February 15 th, 2015 – Applies to all individual plans change plans November 15 th – December 15 th, 2014 You can change plans from November 15 th – December 15 th, 2014 Special enrollment periods are year round!

23. What is a Special Enrollment Period? If a person or family experiences a qualifying life event or in certain other circumstances related to the enrollment process, they may be eligible for a Special Enrollment Period (SEP) This SEP will allow them to enroll in health insurance coverage through the Health Insurance Marketplace outside of a open enrollment period. The individual or family will typically have 60 days from the qualifying life event or approval of their SEP request to enroll in new Marketplace coverage

24. Special Enrollment Periods Marriage Marriage with Dependent Gained Divorce (if loss of MEC) Death (if loss of MEC) Birth Adoption Placement for Adoption Foster Care Placement Permanent Move to New Service Area Becoming Lawfully Present Gaining AI status Income change resulting in change in APTC eligibility (if enrolled) Release from Prison Involuntary loss of ESI Loss of Dependent Status Expiration of COBRA Individual plan non- renewal outside of open enrollment Errors, mis- representation or inaction by enrollment assister QHP misrepresentation or contract violation Technical problems Immigration status error Website display error Unresolved casework Medicaid/Marketplace transfer issues Natural Disaster Serious Medical Condition Victims of Domestic Violence Loss of Hardship exemption

25. What doesn’t trigger a SEP? Voluntarily dropping other coverage Loss of eligibility for coverage when one was not actually enrolled in it Being determined newly eligible for subsidies if you aren’t currently enrolled in a QHP Income change Being terminated from coverage Divorce or death of a family member without it resulting in a loss of MEC

26. The State and Federal Government train and certify individuals who can help you apply for health insurance through the Marketplace: Who Can Help Me? Certified Application Counselors Navigators Non-Navigator Enrollment Assisters Agents & Brokers

27. Explain it to me like I’m 5 years old What does actuarial value mean?

28. What do you know about BadgerCare?

29. BadgerCare Basics BadgerCare is the name for Wisconsin’s Medicaid program which offers health coverage to individuals with low-incomes. AdultsChildrenPregnant Women 100%FPL 200%FPL 300%FPL 400%FPL

30. For context… BadgerCare today is different than it was as recently as April. Many people still may not know they are eligible for it, and others may no longer be eligible for it.

31. When Can You Enroll?

32. Explain it to me like I’m 5 years old What is the difference between an HMO and a PPO?

33. Who Can Help Me? The Wisconsin Income Maintenance Consortia are responsible for processing BadgerCare, FoodShare and Medicaid Applications. Income Maintenance staff are the only individuals who can make an eligibility determination, however anyone can help an individual to apply.

34. Regional Enrollment Networks: Coalitions which came together to help individuals enroll in health coverage Navigator Awards: New Navigator awards will be made next month. Politics: The Affordable Care Act and related Medicaid decisions have been made highly political. General Confusion: Even with one year of open enrollment completed, people are still very confused about their coverage options. Environmental Factors - FYI

36. Thank you! Lisa Olson lolson@wphca.org 608-277-7477